Physical and sexual abuse linked to asthma in Puerto Rican kids

Children who are physically or sexually
abused are more than twice as likely to have asthma as their peers, according to
a recent study of urban children in Puerto
Rico. In fact, physical and sexual abuse was second only to maternal
asthma in all the risk factors tested, including paternal asthma and indicators
of socioeconomic status.

“To our knowledge, this is the first report
of a direct association between childhood abuse and asthma and asthma-related
outcomes,” wrote Robyn T. Cohen, M.D., M.P.H., lead author of the paper of the
Channing Laboratory of Brigham and Women’s Hospital in Boston.

The article was published in the first issue
for September of the American Journal of
Respiratory and Critical Care Medicine, a publication of the American
Thoracic Society.

“We wanted to explore whether exposure to
stress and violence is associated with an increased risk of asthma in urban
children living in Puerto Rico,” said principal
investigator, Juan C. Celedón, M.D., Dr.P.H. “We already know that there is a
high prevalence of asthma in Puerto Rican children, and many studies have linked
stress and exposure to violence to health problems in childhood, including
asthma.”

The researchers interviewed 1,353
parent-child pairs in between 2001 and 2003, and re-interviewed nearly 90
percent of the same pairs two years after their initial interviews. They used
validated questionnaires to elicit information about stress and violence in the
children's lives (whenever possible, without the parent present), and used
doctor-diagnosed asthma, allergic rhinitis, use of prescription medication for
asthma and physician visits for asthma and/or allergic rhinitis within the
previous year to assess the children's asthma/allergy
status.

“Children with a history of abuse had higher
frequencies of all outcomes of interest than those without a history of abuse,”
wrote Dr. Cohen. “After adjusting for relevant covariates, history of abuse was
associated with an approximate doubling of the odds of current asthma,
healthcare use for asthma, and allergic rhinitis.” For example, whereas 15 (20
percent) of the 75 children with a history of abuse had current asthma, 128
(11.5 percent) of 1,117 children without history of abuse had current
asthma.

The study did not, however, find a link
between neighborhood violence and asthma, as other studies have done in the
past. The researchers suggest that the discrepancy may be the result of the fact
that “it is not simply the exposure to a particular stressor but the
physiological response to that stressor that predicts physical health
outcomes.”

Individual responses to stressors such as
community violence will vary, and according to some data, Puerto Rican culture
itself may have protective features. “Latino culture places an emphasis on
certain values and social supports that may buffer the effects of poverty and
community violence experienced by children in Puerto
Rico,” said Dr. Cohen. Direct physical or sexual abuse, however,
could cause a break-down of those buffering systems.

The investigators postulate that abuse may
alter the hypothalamic-pituitary-adrenal (HPA) axis, which in turn may depress
the glucocorticoid response, resulting in decreased suppression of airway
inflammatory responses. Other studies have supported this possibility,
especially among patients with post-traumatic stress
disorder.

But while the exact pathway remains unclear,
and beyond the scope of a cross-sectional study has yet to be ascertained, there
is immediate relevance of the findings for social workers and physicians: “Our
findings highlight the importance of both screening for illnesses such as asthma
in children who are abused and of being aware of the possibility of abuse in
children with asthma,” wrote Dr. Cohen.